Improving mental health and psychosocial wellbeing in humanitarian settings: reflections on research funded through R2HC

Rabih El Chammay,Kevin Savage,Anne Harmer,Alastair Ager,Mark Van Ommeren,Leontien Ruttenberg,Melissa Harper Shehadeh,Courtland Robinson,Robert Colebunders,Wietse A Tol,Samuel Likindikoki,Catherine Panter‐Brick ,Stefan Jansen ,Cécile Bizouerne ,Courtney Welton‐Mitchell ,Richard A Bryant ,Claudia García‐Moreno ,Leah James ,Marx R Leku,Syed Usman Hamdani,Brian J Hall,Michael Pluess

doi:10.1186/s13031-020-00317-6

Abstract

Major knowledge gaps remain concerning the most effective ways to address mental health and psychosocial needs of populations affected by humanitarian crises. The Research for Health in Humanitarian Crisis (R2HC) program aims to strengthen humanitarian health practice and policy through research. As a significant portion of R2HC’s research has focused on mental health and psychosocial support interventions, the program has been interested in strengthening a community of practice in this field. Following a meeting between grantees, we set out to provide an overview of the R2HC portfolio, and draw lessons learned. In this paper, we discuss the mental health and psychosocial support-focused research projects funded by R2HC; review the implications of initial findings from this research portfolio; and highlight four remaining knowledge gaps in this field. Between 2014 and 2019, R2HC funded 18 academic-practitioner partnerships focused on mental health and psychosocial support, comprising 38% of the overall portfolio (18 of 48 projects) at a value of approximately 7.2 million GBP. All projects have focused on evaluating the impact of interventions. In line with consensus-based recommendations to consider a wide range of mental health and psychosocial needs in humanitarian settings, research projects have evaluated diverse interventions. Findings so far have both challenged and confirmed widely-held assumptions about the effectiveness of mental health and psychosocial interventions in humanitarian settings. They point to the importance of building effective, sustained, and diverse partnerships between scholars, humanitarian practitioners, and funders, to ensure long-term program improvements and appropriate evidence-informed decision making. Further research needs to fill knowledge gaps regarding how to: scale-up interventions that have been found to be effective (e.g., questions related to integration across sectors, adaptation of interventions across different contexts, and optimal care systems); address neglected mental health conditions and populations (e.g., elderly, people with disabilities, sexual minorities, people with severe, pre-existing mental disorders); build on available local resources and supports (e.g., how to build on traditional, religious healing and community-wide social support practices); and ensure equity, quality, fidelity, and sustainability for interventions in real-world contexts (e.g., answering questions about how interventions from controlled studies can be transferred to more representative humanitarian contexts).

Highlights

Mental health and psychosocial support in humanitarian settings: the role of research Humanitarian crises, including armed conflicts and disasters, are commonly associated with substantial psychological and social suffering
To cover this broad set of goals, guidelines refer to the composite term ‘mental health and psychosocial support’ (MHPSS), defined as “any type of local or outside support that aims to protect or promote psychosocial well-being and/or prevent or treat mental disorder” [2]
Research may assist in: guiding and prioritizing humanitarian programming by understanding the most critical mental health and psychosocial needs and unpacking the risk, protective, and promotive factors linked to MHPSS concerns; improving interventions by testing assumptions in MHPSS program theories of change; evaluating whether and how both locally and externally developed MHPSS activities meet their aims; examining how proven interventions may most effectively be disseminated and implemented; strengthening needs assessments and program monitoring through the development and testing of measurement tools; and, understanding barriers and facilitators to implementing MHPSS activities [5]

Summary

Background

Mental health and psychosocial support in humanitarian settings: the role of research Humanitarian crises, including armed conflicts and disasters (e.g., triggered by natural or man-made events), are commonly associated with substantial psychological and social suffering. In acknowledgement of the diversity of potential needs and local capacities in humanitarian crises, international guidelines recommend multi-layered, complementary supports that focus on goals ranging from: psychological and social considerations in provision of all humanitarian assistance to protect dignity and human rights (e.g., ensuring the active participation of affected populations, including marginalized communities, in reconstruction efforts; following cultural preferences when burying deceased individuals where possible); strengthening existing family and community support systems (e.g., training facilitators of youth clubs in emotional and social support skills; family reunification); and providing focused care for people with specific mental health and psychosocial problems (e.g., psychotherapeutic and pharmacological interventions for people with mental disorders; communitybased group sessions with perpetrators of gender-based violence) [2]. Jansen and colleagues are testing the effectiveness of a locally-developed community-based intervention with men in reducing gender-based violence in the eastern DRC who are

Design

Conclusions

The Alliance for Child Protection in Humanitarian Action